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What is ‘support’?

There’s a great post over at ‘The Small Places’ that I highly recommend everyone interested in adult social care read (OK, I do realise that that has immediately cut the proportion of people interested but that’s my brief).

The post refers to a case – A London Local Authority v JH – and to sum up, it is a Court of Protection Case which balances on the Article 8 ‘right to family life’ and presents a different side of it to the rather hilarious example misquoted by our esteemed Home Secretary

(I wasn’t going to miss an opportunity to post a picture of a cat!).

The Local Authority in question have proposed that Mrs H is placed in a Nursing Home because her husband, while being offered what they describe as a substantial care package, is basically asking for more support than has been assessed as a need and is not ‘wholly cooperative’ with the process of the support.

I refer you back to ‘The Small Places’ for much better detail about the case.

For me, this reflects the reality of social care much more than the visions of personalisation that exist with other user groups like younger adults with disabilities (although that may change with all budgets reducing).

It highlighted some of the thinking of the local authority and what it means to ‘meet needs’ of a person in a legal sense bearing in mind responsibilities under Section 47 of the 1948 National Assistance Act.

The council deems that 52 hours of support are needed. Mr H feels that he needs 63 (which had been offered in the past when the package was funded through continuing care procedures).

The council offers 3 hours of respite and Mr H feels he needs24 hours of respite.

The council offers Mr H a direct payment (I bet they really wanted him to take that to absolve themselves of some of the responsibilities) but he refused.

The council deemed that Mr H was ‘uncooperative’ because he did not agree with the package which they imposed on him.

He is quoted in the judgement as saying

“If I have refused services on her behalf it is because of our frustration that she was not provided with the level of support that I was told she would receive.””I found myself so frustrated by the lack of support from social services I gave them an ultimatum, provide us with the support we require or do not bother. I had reached the end of my tether at this point …”

He feels very let down by services. He thinks that the financial cuts are more important than patient care.”The judge in the case found that Mrs H should remain with her husband and receive care at home and work with the local authority to establish a support plan but there are a number of assumptions made by the local authority that override the underlying process of choice for the service user and, in this case, carer.

He had been offered 3 hours respite a week and the local authority were not adapting their criteria to look at his individual circumstances. He was offered care in a particular way at particular times.For me, this is the reality of people receiving care in their homes. Different faces, different professionals who claim to ‘know better’, different carers, different nurses, all asking for keys for access or asking for equipment to be installed in what remains a family home.

The one thing that strikes me what can appear to be the tyranny of the system I am a part of. We dictate. We ‘know better’.I thought this was supposed to be behind us with the new way of working towards ‘personalisation’ and ‘personal budgets’ where everyone can CHOOSE.

Mr H was offered a direct payment where, no doubt, he would have had more flexibility to decide his wife’s care but his choice was to refuse it and have assistance in managing the care package. His choice remained a Hobson’s Choice

I think anyone working in social services and adult social care should look at the way we offer choices and what choice we are actually offering.‘You have been assessed as needing x hours of care’ when x = the bare amount needed to continue to exist’ isn’t much of a choice.Even less so if your ‘choice’ involves not taking on direct payments which is the way the government is pushing.Unfortunately, ‘A London Local Authority v JH’ has much more reality for me than some of the idealised ‘personal budget’ planning models that are knocking around various government departments.I’m glad this case came to court and am only disappointed that there has not been more press interest in it because it reflects a reality in social care that really needs to be addressed and challenged if there is every going to be a transformation in the way that services are delivered and that includes my taking a long and hard look at myself and the way that I become a part of this system while considering the best ways to challenge it at the same time.

I became a social worker to embrace ethical practice, not to file it away with my pay check.